2025 Poster Presentations
P264: INNOVATIVE CUSTOMIZATIONS TO POROUS POLYETHYLENE CRANIOPLASTY IMPLANTS FOR ENHANCED COSMESIS IN ANTERIOR SKULL BASE RECONSTRUCTION
Bethany J Andrews, MD1; Olivia E Gilbert, MD1; Brian Thorp, MD, FACS1; Carolyn Quinsey, MD2; 1University of North Carolina; 2University of Missouri
Repairing frontal calvarial defects poses significant challenges due to aesthetic demands and the need for functional restoration, both of which require a thorough understanding of intricate anterior skull base anatomy. Beyond cosmetic improvement, the goals of frontal cranioplasty are to provide structural support for the brain and orbits, separate intracranial and extracranial contents with a water-tight seal to prevent CSF leaks, and minimize dead space. Multiple reconstruction materials are available for cranioplasty, each selected based on patient-specific factors. While autologous bone is often preferred given its strength, availability, osteoconduction, and compatibility, many synthetic alternatives are available including porous polyethylene, titanium, hydroxyapatite, polymethylmethacrylate, and polyetheretherketone. Porous polyethylene implants, which can be custom-designed preoperatively, combine the durability, structural support, and biocompatibility of autologous bone while fostering fibrous tissue infiltration and bone growth to reduce extrusion rates. Here, we report two cases of secondary anterior skull base reconstruction using custom-designed porous polyethylene implants, including several innovative customizations for enhanced cosmesis.
The first patient is an 18-year-old male with a history of severe TBI necessitating bifrontal craniectomy followed by skull base repair and titanium mesh placement at an outside facility, who presented with mucocele, CSF rhinorrhea, and pneumocephalus. The second patient is a 29-year-old female with a history of self-inflicted gunshot wound to the head necessitating multiple skull base repairs and titanium mesh placement at an outside facility, who presented with brow asymmetry and skull base defect. Both patients underwent titanium mesh removal and frontal sinus cranialization. The first patient required temporalis fascia and muscle grafts as well as a latissimus dorsi free muscle graft for sinus obliteration. This was followed by cranioplasty with modifications to thin the flange and to eliminate the flange as the implant met the orbital bar (Figures 1, 2). The second patient required a multilayered skull base repair including vastus lateralis muscle plug, temporalis graft, and obliteration of the frontal sinuses followed by cranioplasty. For this patient, the flange was ultra-thin (0.85 mm), and a drill was used to contour the inferior edge of the flap in order to facilitate cosmesis (Figures 3, 4). Both patients had excellent postoperative outcomes with no complications, achieving successful skull base repair and superior cosmetic results.
Although cosmesis has not traditionally been a primary focus in skull base reconstruction, these innovative modifications to cranioplasty implants offer a replicable approach that can be adapted to suit the specific needs of patients and their reconstruction.
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